The cost of providing care in the nursing home is substantially less than the existing home care package, the HSE said.

Mr Justice Peter Kelly will also, arising from disagreement between the woman’s parents and the HSE on the matter, decide issues concerning the circumstances to which a “do not resuscitate” notice should apply to her.

The issue of future care arises because the woman is a ward of court and a €2.6 million settlement secured by her in High Court personal injury proceedings in 2013, which had funded her home care, has run out.

That settlement, made against the HSE without admission of liability, arose from a claim of delay and negligence in the diagnosis of a brain tumour.

Her parents are anxious to ensure she continues to receive care to the same standard she has received at home via a package designed by her GP and consultants.

On Tuesday, their counsel told Mr Justice Kelly the parents are anxious the court remains involved and decides the care issues in her best interests.

Noting the woman’s €2.6 million settlement was calculated by reference to a life expectancy she has now exceeded, the judge said that seemed to be a result of the “quite superb” care she has at home in a regime instituted by her family and involving a very committed GP, consultants and regime of nursing “second to none”.

‘Superb’ treatment

A court-appointed independent medical visitor who assessed the woman had reported she has a “superb” treatment regimen which the visitor suspected could not be replicated in a community setting or elsewhere.

The woman’s funds have gone and the question is what happens next, the judge said. The HSE said care should be provided in a nursing home setting, that will cost less and is appropriate, he said.

The family disagreed because of past experiences they have had and wished to stay looking after the woman as they had to date, he noted. His task was to decide, on the medical evidence, what is in the woman’s best interests.

If he decides home care should continue, the issue of funding that care would then have to be decided. The HSE had said, if it was funding home care, it wanted “clinical governance” over that.

The HSE is entitled to know that funds provided by it are spent on care, and that could be done via the court, he said.

If the HSE also wanted some form of medical or nursing supervision over the woman’s care, and to have her current medical and nursing team excluded from such governance, the court needed to know that, and the HSE must specify within 14 days what it wanted in that regard.

‘Very serious’

The judge noted the woman’s parents, who are the committee representing her interests, are aware her situation is “very serious”. Having taken advice from her GP, the parents have indicated, if certain events occur, she should not be resuscitated, he noted.

The HSE is dissatisfied with that particular “do not resuscitate” agreement and says it should be qualified further, but it has yet to indicate exactly what qualification should be made, he said.

The HSE should set out in 14 days what it considers should be in the notice, he said. The judge also directed that an independent review of the DNR issues be carried out by a consultant respiratory physician for the benefit of the court.

He adjourned the matter for three weeks so the necessary information can be provided.